intertan technique guide

The InterTan nail system, designed for hip fracture treatment, incorporates an integrated compression mechanism. This guide outlines the surgical technique utilizing the Trigen InterTan system and the Gold Instrument Set, as well as minimally invasive approaches, as described in the surgical technique brochure.

The InterTan nail system represents a significant advancement in the treatment of intertrochanteric and subtrochanteric hip fractures. This intramedullary nail, primarily used for these fracture types, offers unique biomechanical advantages over traditional methods. Its design incorporates two integrated cephalomedullary screws in the femoral neck region, enhancing rotational stability. This is a critical feature for promoting fracture healing and minimizing complications such as non-union. The InterTan system also features an integrated compression mechanism, allowing for controlled axial compression at the fracture site.
The Trigen InterTan nail is shaped specifically for proximal femur fractures. This anatomical design ensures a press-fit within the hip bone, providing strength and stability where forces are concentrated. Compared to single-screw cephalomedullary nails like the Proximal Femoral Nail Anti-rotation (PFNA), the InterTan’s dual-screw configuration offers superior resistance to rotational forces. Clinical studies have shown that the InterTan nail leads to favorable clinical outcomes, including reduced failure rates and improved patient mobility, and is often preferred for its biomechanical properties. The system includes specialized instruments, such as the Trigen InterTan Gold Instrument Set, designed to facilitate precise and efficient implantation.

Indications for InterTan Nail Use

The Trigen InterTan Intramedullary Nail is indicated for a variety of hip fractures, with primary application in the treatment of intertrochanteric and subtrochanteric fractures. These fracture types, common in elderly patients, often require surgical intervention to restore stability and promote healing. The InterTan nail provides a stable fixation method that allows for early weight-bearing and mobilization, crucial for preventing complications associated with prolonged immobilization.

Beyond standard intertrochanteric and subtrochanteric fractures, the InterTan nail can be employed in the management of periprosthetic fractures occurring around hip replacements. These fractures present unique challenges due to the presence of the existing implant and potential compromise of bone quality. Additionally, the InterTan nail is suitable for addressing non-unions of the proximal femur. In cases where a previous fracture has failed to heal properly, the InterTan nail can provide the necessary stability and compression to encourage bone formation. The dual-screw design and integrated compression mechanism are particularly beneficial in these complex fracture scenarios, promoting enhanced rotational and axial stability, contributing to successful outcomes.

Preoperative Planning for InterTan Procedure

Comprehensive preoperative planning is crucial for successful InterTan nail fixation. This phase involves careful assessment of the patient’s overall health, fracture pattern, and bone quality. Begin with a thorough review of the patient’s medical history, including any comorbidities that may affect surgical risk or healing potential. Detailed radiographic evaluation, including AP and lateral views of the hip and femur, is essential to classify the fracture type and identify any associated injuries.

The fracture pattern dictates the reduction technique and implant selection. Assess the degree of comminution, displacement, and any rotational deformities. Evaluate bone quality, considering factors like osteoporosis, which can impact screw purchase and overall stability. Preoperative templating using the TRIGEN INTERTAN Nail Preoperative Template Set (7167-4200) is recommended to determine appropriate nail length, screw length, and entry point. This step helps anticipate potential challenges and ensures optimal implant fit. Furthermore, consider the patient’s anatomy and any pre-existing deformities that may influence surgical approach and implant positioning. Anticipating potential difficulties preoperatively allows for adjustments in surgical strategy and ensures a smooth and efficient procedure.

Implant Selection for InterTan Nail

Selecting the appropriate InterTan nail implant is paramount for achieving optimal fracture fixation and patient outcomes. This process involves considering several factors, including fracture type, patient anatomy, and bone quality. The InterTan nail system offers a range of nail lengths and diameters to accommodate varying femoral sizes. Preoperative templating, utilizing the TRIGEN INTERTAN Nail Preoperative Template Set (7167-4200), is strongly advised to accurately determine the required nail length and diameter.

Furthermore, the choice of screw length is critical. The screws must be long enough to achieve adequate purchase in the femoral head while avoiding penetration of the joint. Bone density should also influence screw selection, with longer screws often preferred in osteoporotic bone. The InterTan system offers various screw lengths to accommodate different anatomical variations. In cases of subtrochanteric fractures, a longer nail may be necessary to provide sufficient distal fixation. Careful consideration of these factors ensures appropriate implant selection, optimizing stability and promoting successful fracture healing. Ultimately, a well-chosen implant contributes significantly to a positive patient outcome.

Surgical Technique: Insertion of InterTan Nail

The insertion of the InterTan nail requires meticulous surgical technique to ensure proper placement and stability. The procedure typically begins with the patient positioned supine on a fracture table. A small incision is made at the greater trochanter, and the entry point is prepared using specialized instruments from the TRIGEN INTERTAN Gold Instrument Set. Careful attention must be paid to ensure the entry point is in the correct location to facilitate proper nail alignment.

Following entry point preparation, the femoral canal is sequentially reamed to the appropriate diameter, as determined by preoperative templating. The InterTan nail is then carefully inserted into the canal, ensuring it passes smoothly to the desired depth. Fluoroscopy is used throughout the insertion process to confirm correct positioning and alignment. Once the nail is in place, the integrated cephalomedullary screws are inserted, providing rotational stability to the fracture fragments. The screws are advanced until they achieve optimal purchase in the femoral head. Final fluoroscopic images are obtained to verify proper implant placement and fracture reduction. The incision is then closed in layers.

Reduction Techniques for Specific Fracture Types

Achieving adequate fracture reduction is paramount for successful InterTan nail fixation. Different fracture patterns necessitate specific reduction techniques. For intertrochanteric fractures, closed reduction maneuvers, such as traction and rotation, are often employed to restore alignment. In cases of significant displacement or comminution, percutaneous reduction clamps may be used to manipulate fracture fragments into the desired position.

Subtrochanteric fractures, particularly Seinsheimer Type V, may require more complex reduction strategies. Minimally invasive clamp-assisted reduction has shown encouraging results, providing excellent alignment and fixation. This technique involves the use of specialized clamps to indirectly reduce the fracture fragments through small incisions. For periprosthetic fractures, careful attention must be paid to the existing implant. Reduction techniques may involve a combination of closed and open methods, depending on the fracture location and stability of the prosthesis. The goal is to achieve anatomical alignment, restore limb length, and ensure stable fixation to promote bone healing.

InterTan Nail: Achieving Rotational Stability

Rotational stability is a crucial factor in the successful treatment of intertrochanteric hip fractures. The InterTan nail is specifically designed to enhance rotational control of the proximal fragment. Unlike traditional cephalomedullary nails with a single screw, the InterTan system features two integrated cephalomedullary screws. This dual-screw configuration provides increased resistance to rotational forces, minimizing the risk of fragment displacement and nonunion.

The integrated compression mechanism further contributes to rotational stability by allowing for controlled axial impaction at the fracture site. This compression enhances fracture apposition and promotes bone healing. The press-fit design of the InterTan nail within the proximal femur also contributes to its overall stability. The nail’s shape is designed to provide optimal contact with the surrounding bone, resisting rotational movement. By addressing rotational instability, the InterTan nail helps to improve clinical outcomes and reduce the incidence of complications associated with hip fracture fixation.

Postoperative Management and Rehabilitation

Following InterTan nail fixation, a structured postoperative management and rehabilitation protocol is essential for optimal patient recovery. Initial management focuses on pain control, wound care, and prevention of complications such as infection and thromboembolism. Weight-bearing protocols are typically initiated based on fracture stability and surgeon preference, often progressing from non-weight-bearing to partial weight-bearing as tolerated. Early mobilization is encouraged to minimize the risk of deconditioning and promote functional recovery.

Rehabilitation programs should be individualized to address patient-specific needs and goals. Physical therapy plays a crucial role in restoring range of motion, strength, and balance. Exercises targeting hip and lower extremity muscles are essential for regaining functional independence. Assistive devices, such as walkers or crutches, may be used initially to provide support and stability. As healing progresses, patients gradually transition to full weight-bearing and independent ambulation. Regular follow-up appointments are necessary to monitor fracture healing, assess functional progress, and address any complications. Patient education regarding activity modifications and fall prevention strategies is also an important component of postoperative care.

Potential Complications of InterTan Nail Fixation

While InterTan nail fixation offers numerous advantages in treating hip fractures, potential complications can arise, necessitating careful attention and management. These complications may include infection, both superficial and deep, requiring antibiotic therapy or surgical intervention. Nonunion or delayed union can occur, potentially demanding revision surgery or bone grafting. Implant-related issues, such as screw breakage or nail migration, may necessitate further procedures for stabilization.
Malreduction of the fracture can lead to persistent pain or functional limitations. Avascular necrosis (AVN) of the femoral head is a serious concern, potentially requiring hip replacement. Nerve injury, particularly to the sciatic or femoral nerve, can result in sensory or motor deficits. Thromboembolic events, like deep vein thrombosis (DVT) or pulmonary embolism (PE), are potential risks requiring prophylactic measures. Additionally, hematoma formation, wound dehiscence, and heterotopic ossification can occur. Vigilant monitoring, meticulous surgical technique, and appropriate postoperative care are crucial for minimizing the risk and effectively addressing any complications that may arise after InterTan nail fixation.

Technique for Removal of Broken InterTan Screw

Removing a broken InterTan screw presents a unique challenge, often due to implant fatigue failure or nonunion. Careful planning and specialized instruments are essential. Initially, expose the lateral aspect of the femur, visualizing the nail and screw head. If the screw head is accessible, use a screw extraction set, employing a cannulated drill to create space around the screw. A specialized extraction device can then engage the screw head, allowing for controlled removal.

If the screw is broken flush with the nail or bone, a more complex technique is required. Carefully drill a pilot hole into the broken screw, followed by inserting a small, reverse-threaded tap. This tap engages the screw fragment, enabling controlled unscrewing. In cases of significant osseointegration, an osteotome may be needed to release the screw from the surrounding bone. Fluoroscopic guidance is crucial throughout the procedure to prevent damage to the femur or surrounding structures. Post-removal, assess the screw tract for bone defects and consider bone grafting if necessary to promote healing and stability.

InterTan vs. Other Cephalomedullary Nails (PFNA)

The InterTan nail and Proximal Femoral Nail Antirotation (PFNA) are both cephalomedullary nails used for treating intertrochanteric hip fractures, but they differ in design and biomechanical properties. The InterTan nail features two integrated cephalomedullary screws, designed to enhance rotational stability and compression at the fracture site. In contrast, the PFNA typically utilizes a single, large-diameter screw or blade for femoral head fixation.

Studies comparing the two implants have investigated clinical outcomes, including fracture healing rates, complication rates, and functional recovery. Some research suggests that the InterTan nail’s dual-screw configuration may provide superior rotational control, potentially reducing the risk of malrotation and nonunion, particularly in unstable fracture patterns. However, other studies have shown comparable outcomes between the two implants. The choice between InterTan and PFNA often depends on surgeon preference, fracture characteristics, and patient-specific factors. Surgeons should consider the biomechanical advantages and limitations of each system when selecting the optimal implant for a given patient.

Minimally Invasive Techniques with InterTan Nail

Minimally invasive surgery (MIS) techniques have gained popularity in InterTan nail fixation for hip fractures, aiming to reduce soft tissue trauma, blood loss, and postoperative pain. These techniques typically involve smaller incisions and specialized instrumentation to insert the InterTan nail and secure the fracture.
One approach involves a limited lateral incision for nail insertion, guided by fluoroscopy. Fracture reduction can be achieved using closed techniques or percutaneous manipulation, minimizing extensive surgical exposure. Another technique utilizes clamp-assisted reduction, particularly for complex fracture patterns like Seinsheimer Type V subtrochanteric fractures, facilitating accurate alignment through small skin incisions.

MIS with InterTan nails offers potential benefits, including faster recovery, reduced infection risk, and improved cosmesis. However, it requires specialized training and meticulous surgical technique to ensure accurate fracture reduction and implant placement. Careful patient selection and adherence to established protocols are crucial for successful outcomes. The use of intraoperative imaging is essential to confirm proper alignment and implant positioning during the procedure.

Outcomes and Clinical Results of InterTan Fixation

InterTan nail fixation has demonstrated favorable outcomes in treating various hip fractures, including intertrochanteric and subtrochanteric fractures. Clinical studies have reported high union rates, low complication rates, and improved functional outcomes with InterTan nails. The integrated compression mechanism and dual screw fixation provide enhanced rotational stability, promoting fracture healing and reducing the risk of malunion.

Compared to other cephalomedullary nails, InterTan nails have shown comparable or superior results in terms of fracture healing, time to weight-bearing, and functional recovery. Minimally invasive techniques with InterTan nails have further improved outcomes by minimizing soft tissue damage and promoting faster rehabilitation.

However, potential complications such as nonunion, implant failure, and infection can occur, necessitating careful surgical technique and postoperative management. Long-term studies are needed to evaluate the durability of InterTan fixation and assess the incidence of late complications. Patient selection, fracture pattern, and surgeon experience are crucial factors influencing the success of InterTan nail fixation. Further research is ongoing to optimize surgical techniques and improve clinical outcomes.